Baseline Physical Activity Guideline Attainment and Mortality Across Cardiovascular-Kidney-Metabolic Syndrome Stages

Baseline meeting the 2023 AHA CKM physical activity guideline is linked to lower all-cause mortality overall (HR 0.774; 95% CI 0.675–0.888) in NHANES 2007–2018 adults.

• Why it matters: The CKM staging framework enables risk stratification, but it is unclear how guideline-level physical activity relates to mortality across CKM stages.
• What they did: Using an observational target-trial emulation with NHANES 2007–2018 linked to the National Death Index through 12/31/2019, weighted Cox models compared guideline attainment versus nonattainment within CKM stages 1–4.
• The result: Stage-specific all-cause associations were nonmonotonic (HRs 1.030, 0.803, 0.642, 0.727), with five-year risk differences of +0.040, -0.830, -1.790, and -3.840 percentage points; cardiovascular mortality showed a similar overall association (HR 0.707; 95% CI 0.547–0.914).

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